Wed. Dec 1st, 2021


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A new study shows that changes at the system level in the way cancer treatment is performed can also eliminate black-and-white differences in survival from early stages of lung and breast cancer. By identifying and addressing barriers that prevented patients from completing radiotherapy for cancer, the intervention improved five-year survival rates for all patients and eradicated the survival gap between black and white patients. The results will be presented today at the American Society for Radiation Oncology (ASTRO) annual meeting.

The Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) clinical trials is the first prospective study designed to eradicate gaps in cancer treatment completion and survival among black and white patient populations. “Thousands of studies have looked at racial differences in health care, but until recently very few studies have implemented interventions to eliminate these differences,” said lead author Matthew A. Manning, MD, a radiation oncologist and head of oncology at Cone Health in Greensboro, North Carolina. “This study shows that it can be done.”

The ACCURE approach involved several changes in the way patients were supported while receiving cancer treatment. The process had four components: (1) an electronic health record with automatic alerts to mark missing appointments or unfulfilled milestones in expected care; (2) a nurse navigator trained in race-specific barriers to help patients overcome barriers to care when alarms are marked; (3) a physician, to engage health care teams with race-related feedback on completed treatment; and (4) regular health equality training sessions for staff.

Previously published results showed that the ACCURE intervention greatly reduced differences in treatment implementation rates for black and white patients who received curative radiation therapy or surgery for the early stage of breast or lung cancer. In the new study, researchers examined whether the increased completion rates led to improved outcomes, paying particular attention to whether the intervention reduced racial differences in cancer survival. They compared five-year survival rates for 1,413 patients with stage 0, I, and II lung and breast cancer treated after the procedure began with 2,016 patients treated before the system changes.

Prior to the intervention, the five-year survival rate for black patients with breast cancer was 89% compared to 91% for white patients. After the system-level changes began, the five-year survival rate for both groups rose to 94%. Among those treated for early-stage lung cancer, the survival rate increased from 37% to 54% for black patients and from 43% to 56% for white patients.

“Historically, black and white patients had different survival rates after treatment, but that difference disappeared,” said Dr. Manning. “We are now able to say that this intervention eliminated inequalities in overall survival.”

Black people face the highest cancer death rate and the shortest cancer survival rate of any race / ethnic group in the United States. According to the American Cancer Society, black populations also encounter “greater barriers to cancer prevention, detection, treatment, and survival.” By identifying and addressing the specific obstacles facing their patient populations – such as limited access to transportation or difficulty taking time off work without penalty – and consciously examining how obstacles varied by race, the ACCURE team was able to curb the negative impact of these barriers, said Dr. Manning.

“The bottom line is that unless we ask what happens when an appointment or milestone is missed, then we just do not know what is going on and the patient may never come back to us. If we ask, we often have systems “in place. who can solve these barriers. We can arrange transportation or give a letter to the patient for work. We can overcome many barriers, both internal and external to our healthcare institutions, but only if we know what they are.”

Dr. Manning’s Hospital previously conducted a pilot study that showed that a free carpooling program to transport patients to radiation therapy sessions reduced the number of absences among vulnerable populations.

An emphasis on structural, institutional change rather than individual change to combat inequality was key to the success of the ACCURE trial, said Samuel Cykert, MD, professor of medicine at the University of North Carolina School of Medicine and lead researcher on the trial. “The burden of change lies with the system, not the individual patient. People can not give up if they miss a day of treatment because, for example, they have a child to take care of. The intervention also marks delays in care within the health area itself. occurs even when patients do not miss appointments. “

“The clinic can provide safety nets by introducing a method to mark these obstacles and delays and by having steps in place to help the patient return to and complete treatment. That made all the difference with this trial,” said Dr. Cykert.

Investigators took direction from the founding work of the Greensboro Health Disparities Collaborative – a long-standing, community-initiated partnership between medical, academic and community representatives – as they designed the intervention, said Christina Yongue, MPH, MCHES, an assistant professor of public health at the University of North Carolina at Greensboro and project manager for the ACCURE trial.

“The key concepts that drive ACCURE – transparency, accountability and improved communication – came out of this collaboration and workshops on racism, which were required for suppliers and staff,” said Ms. Yongue. “These pillars were crucial in building trust in our research participants, especially with black patients who have historically been marginalized in health care. The clinical outcomes would not have been possible without this trust.”

In the future, the ACCURE team will consider other applications for the intervention, such as addressing inequalities in pregnancy / maternity care. “We have shown that it is possible to eliminate differences in the completion of cancer treatment, and that this change has the potential to close cancer survival holes downstream,” said Dr. Manning. “But we think the application can be much broader.”

Trials address racial differences in treatment for early lung and breast cancer patients

More information:
Conference:… / 2021 / Annual-Meeting

Provided by the American Society for Radiation Oncology

Citation: Intervention eliminates black and white gaps in survival from early stage of breast and lung cancer (2021, October 25) Retrieved October 26, 2021 from gaps- survival-early-stage.html

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